Ultrasound Device No. 1 – Sonon by LimbsandThings

Pre-amble!

So here is Part 1 of the as promised portable ultrasound reviews. The aim, to un-muddy the water a bit for you all over choice and functionality. There are so many put there at the moment, we wanted to test them on the shop floor…are they the true ITU workhorses you need to keep in your pocket?

All reviews are clearly done by myself, unless stated otherwise, so you could argue are very subjective. I can’t disagree…but I will try to be as un-biased as I can and start with an open mind on it all. I own my own GE Vscan DP device as a declaration, but I am not receiving any money / sponsorship or anything else financial from the kind companies who have agreed to allow me to review their devices.

 

Sonon – LimbsandThings

I came across this company whilst teaching on our ED ultrasound course here in Northampton. They essentially  supply mannequins for procedure based training (everything from central access models, to full spines for LP / spinal / epidural training).

Screen Shot 2018-08-13 at 16.59.40.pngSo…they also do portable ultrasound!??

Screen Shot 2018-08-13 at 12.43.26

The device I will be discussing here was produced as a complement to their models. We are using ultrasound for everything these days…putting in central lines, inserting abdominal and chest drains as well as now scanning backs to aid central neuraxial blocks and epidural insertion in difficult patients. Obviously, the main and most massive area of growth and interest is within POCUS (echo, chest scanning, abdominal scanning, DVT and vessel scanning etc). So, they developed a machine that could be used to demonstrate the usefulness of their models and to be used in the fields, as it were.

So, this is the first machine to be reviewed in this series on the portable ultrasound devices.

My contact was Ka-Man Tang, email:

kaman.tang@limbsandthings.com

What is it?

It’s called Sonon. Strange name, but it comes from a Korean company called Healcerion. Click here for their site. You can download their brochure here. Their statement:

Healcerion offers a mobile-based ultrasound system that is specifically designed to provide physicians and patients with flexibility and portability. With our experience in emergency medicine and related medical fields, our team understands the importance of accurate, timely diagnostic testing results and actionable information. We are committed to delivering this information to ensure superior patient care and increased satisfaction for both patients and healthcare providers.

The device comes with 2 probes, a linear and curvilinear set to choose from. No phased array cardiac probe, which was disappointing to me. The screen for these devices comes in the form of connection to an iPad or iPhone. The one I tested came with an iPad mini. Each probe relies on a separate battery, which is removable and rechargeable. The company say you can get a couple of hours out of one charge, which surprises me rather, when you see the size of the probes!

Below is the linear probe:

And the curvilinear equivalent:

No phased array!!!😩😩😩

Screen Shot 2018-08-13 at 12.43.43

What’s it like then – hands on?

  1. Once laid on the bench, the first thing you have to do is access the settings menu on the iPhone or iPad, then turn on the probe by squeezing the power switch for a few seconds.IMG_4842 IMG_2486
  2. Next, you have to find the wireless probe’s unique Wifi output signal and connect to it entering the passcode supplied by the company. A flashing white light from the edge of the probe then turns solid green, and connection is ready. This took a few minutes to do. You have to do this for each type of probe, and only one can be connected at a time.
  3. Then, you open the Sonon app on the iPad, click ‘start scanning’….and you’re off as it were!

IMG_3766

Screen Shot 2018-08-13 at 13.52.31

Screen Shot 2018-08-13 at 16.31.13

The scans!

The first thing I did was grab our kind ODP from theatres and did a few basic views. Obviously, I felt a tad limited here, being as there is no phased array probe to perform cardiac and a few other basic scans. So, straight onto chest and abdomen with the curvilinear probe then!

Curvilinear views

IMG_9440
Very basic upper thoracic scan, with inter-rib chest views. Note, grainy image with lack of A-line visibility as well as un-discernable pleural slide.
IMG_8897
Note the abdominal aorta as it divides into the common iliacs. Reasonable view of the spinous process and its acoustic shadow. Over-depth here, obviously!
IMG_2630
Best obtainable view of the hepato-renal angle I could muster! Even with a good fiddle on settings and dynamic gain, I could not eradicate the distal echo-brightness.
IMG_0236
View of the left kidney and transverse view of the abdominal aorta.

 

 

IMG_4135
An attempt at IVC view….rather grainy and frankly, hard to measure!

 

IMG_4135
An attempt at IVC view….rather grainy and frankly, hard to measure!

Linear views

Finally, onto the linear probe. Once I had opened up the curvilinear probe, removed the battery, swapped it over into the linear, re-paired the probe and re-opened the app, we were off! This took another 5 minutes.

IMG_8204
Median nerve at the wrist. Good view, but again, despite fiddling with the settings, rather too echo bright for me!
IMG_8922
Scan of the radial nerve at the elbow. Rather too echo-bright, but reasonable in demonstrating the target for a radial nerve block.
IMG_8243
Transverse view of the median cubital vein and radial artery in the upper forearm. Reasonable image.

The verdict!

Below, is a review template we came up with in order to fairly assess portable devices (mainly credit to Adrian Wong for this).

Criteria for the perfect handheld POCUS device

General

Portability

  • This device, although portable, comes with 2 separate probes and a separate ‘screen’. Therefore, for me, a tad clunky really. I do not want to have to carry 2 large probes about wherever I go, both of which could easily go ‘walkies’ and an iPad. Connection to my iPhone may be a bit different, but I didn’t have the option to review this.

Number of probes

  • 2…why oh why is there not a 3rd phased array echo probe?? The better option, perhaps, would have been a dual end probe, similar to GE’s Scan devices.
  • Too many probes means connectivity hassle, which I talked about above.

Screen – dedicated or linked to tablet/phone

  • As above, this relies upon a separate screen, iPad or iPhone and wireless connectivity. It isn’t hot wired and I find this a comfort for some reason.

Battery life

  • I did not test this to battery empty point. Many portables have been pulled apart over terrible battery life. This one, according to the company, and judging by the size of the batteries, goes on for a couple of hours? The beauty of devices like this (not hard wired), are that the probes and screens are not related to the same battery life, which should give you more scan time.

Interface logistics and ergonomics – touchscreen, user-friendly software

  • The software was relatively easy to use, but, and it’s a biggie, the software slowed down and gave a clunky, slow refresh rate when moving the probe and fanning about. Once colour flow was activated, it got even worse!
  • The interface and zoom / gain was relatively intuitive, however, the touch screen is fiddly to use. There is often a place for physical dials and buttons with ultrasound…they seem to offer more accurate and responsive alteration to settings etc.

Cost

  • The SONON probes cost:
    • Linear £7,500
    • Convex £6,500

This is steep, when other devices with dual probes cost less or equivalent! Prices also exclude VAT and carriage.

Warranty

Unsure but the company say they will provide aftercare service – vital!

Echo probe

N/A😩

Curvilinear probe

Ergonomics – weight, feel

  • Rather cumbersome, and there’s an image freeze button located slap bang in the centre of the probe, which was all too easy to knock. Rather annoying!

Image quality

  • As above, rather grainy and areas were extremely echo bright in tendency. Rather a lot of fiddling about is needed to optimise things. Perhaps this would become more apparent and easier to resolve the more time you spend with the device? The resolution was just not there when placed against other devices.

Features

  • Freeze button, Wifi link button and battery level indicator on the probe.

Linear array probe

Ergonomics – weight, feel

  • Rather cumbersome again, and there’s that same image freeze button located slap bang in the centre of the probe, which was all too easy to knock. Rather annoying!

Image quality

  • The image quality and user-friendliness of the linear probe for me, was superior to the curvilinear probe. But, echo brightness tendency was huge. Detail of scanned nerves was nowhere near to that of other devices I have seen. Again, fiddling about was needed to optimise the image. The device was good for superficial vessel scanning though.

Features

  • Freeze button, Wifi link button and battery level indicator on the probe.

Video’s of the device in action

 

Score and conclusion

This device scored 5/10 for me.

I would not buy one for personal use (rather expensive – you are talking £14,000 before you even consider VAT and carriage). I would support the concept of it’s creation – to support basic training on mannequins / models for basic procedures. I would not hang my hat on its images to make diagnostic decisions. The other factor here for me, is that this company does not have a history and background within ultrasound as such. This must always be considered. There are others who dedicate their technology and R&D purely to this cause.

I must think LimbsandThings for allowing us to review the device and also want to state that I received no payment for this and similarly have no conflicts of interest to declare.



 

Next up:

Part 2 – The GE Vscan DP & Vscan extend!

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